Despite Lisa Murkowski’s Deals, Alaskans Will Suffer Under Trump’s Tax Bill

WASHINGTON – Sen. Lisa Murkowski (R-Alaska) understands how devastating President Donald Trump’s tax bill is going to be for millions of people around the country.

She said so right after she voted to pass it on Tuesday.

“This has been an awful process,” she said in a lengthy statement, lamenting both the terribleness of the bill and the rush to get it done. “While we have worked to improve the present bill for Alaska, it is not good enough for the rest of our nation ― and we all know it.”

Murkowski had a shot at potentially killing this bill. With the Senate vote stuck at 49-50, she wavered on how to vote for hours, all through Monday night and into Tuesday morning, as GOP colleagues surrounded her on the Senate floor and subjected her to an intense, exhausting lobbying campaign to support it. She ultimately did, bumping the final vote to 50-50 and clearing the path for Vice President J.D. Vance to break the tie.

The House passed the bill Thursday, and it’s off to the White House to be signed into law.

This legislation, Trump’s signature domestic policy package, is going to inflict a lot of pain and cruelty on a lot of people. It gives immigration authorities $150 billion to ramp up Trump’s mass deportation efforts, with more money for detention centers and more incentives for detaining American children with undocumented parents. It kicks millions of low-income people off health insurance. It takes food assistance away from millions more people and families. In exchange for its more than $1 trillion in cuts to Medicaid, it gives a hefty tax break to the wealthiest Americans.

Murkowski seemed to have buyer’s remorse almost immediately after voting for it. In her Tuesday statement, she bizarrely said she wanted to keep working on the bill, even as Republican leaders have been racing to get it to Trump by Friday, leaving little to no chance for more changes to it once it left the Senate.

“My sincere hope is that this is not the final product,” she said. “This bill needs more work across chambers and is not ready for the President’s desk.”

So why did the Alaska Republican vote for this thing? Her reasoning is as cynical as it is a sign of how broken our politics have become: She was able to add language to the bill shielding her state from some of the suffering the bill will inflict on the rest of the country.

In exchange for her vote for the bill, Murkowski secured a two-year delay in cuts to her state’s federal dollars from the Supplemental Nutrition Assistance Program, which provides food aid to low-income people — even as this provision, crafted just for her state, creates a bizarre incentive for states with the highest error rates to overpay their SNAP recipients.

She negotiated another $25 billion for a now $50 billion fund for rural hospitals, many of which will struggle to survive the bill’s deep Medicaid cuts. She got a perk for Alaska whaling captains. She got more drilling leases for her state. She delayed the termination of wind and solar tax credits, which Alaska benefits from, and stripped a new tax on renewable energy projects.

“I advocated for my state’s interests,” Murkowski told reporters after Tuesday’s vote. “I will continue to do that and I will make no excuses for doing that.”

The thing is, her constituents are still going to suffer under this bill.

As many as 46,000 Alaska residents are at risk of losing their health insurance because of the bill’s harsh new work requirements and frequent eligibility checks for Medicaid. Another 27,000 Alaskans are at risk of losing food assistance because of harsh new work requirements in the SNAP program. The perks Murkowski added to the bill on both of these fronts delay these hits from taking effect by a year or two, but don’t stop them.

When the Medicaid cuts take effect, it will put a huge strain on the state’s health care system, with hospitals and clinics potentially being forced to cut services, increase costs for privately insured patients, or simply close. Four rural hospitals in Alaska, which comprise 40% of the state’s rural hospitals with available data, serve high concentrations of Medicaid patients.

Murkowski negotiated more money for the previously mentioned $50 billion rural hospital fund to help with this, but it’s not even close to offsetting the bill’s more than $1 trillion in cuts to Medicaid. Rural areas are going to lose $155 billion in federal Medicaid dollars under the bill, per an analysis by KFF, an independent health policy research group. Alaska is estimated to get about $280 million from the rural hospital fund over five years.

Another “super concerning” aspect of the bill for Alaska residents relates to the state not having any Level 1 Trauma Centers, said Liz Pancotti, the managing director of policy and advocacy at Groundwork Collaborative, a progressive economic policy think tank.

When Alaskans need Level 1 trauma care, which is the highest level of trauma care for critically injured patients, they are transported via medical evacuation to hospitals in Washington state, Pancotti said. Murkowski may have gotten reassurances from Trump officials that hospitals in her state can access the $50 billion rural hospital fund to offset its Medicaid cuts, but those assurances won’t likely apply to hospitals in Washington state.

“Who knows if that state, which has a Democrat governor and Democrat senators, is going to get any money out of the rural hospital stabilization fund,” she said. “Probably not. And also, they’re not rural. Their centers are on the coast or in the cities.”

Pancotti said it will “presumably” be Health and Human Services Secretary Robert F. Kennedy making the calls on which states can tap into the rural hospital fund.

“Why would you give money to the governor of Washington for Alaska?” she asked. “Maybe Murkowski can make that case, but it feels like there’s no guarantee.”

The state’s budget will also take a huge hit, as Alaska, like all other states, will now have to pay for its share of Medicaid. The bill headed to Trump’s desk would result in Murkowski’s state losing at least $2 billion in federal Medicaid funds over the next decade, per KFF.

State legislators will be pressed to offset those losses by making cuts to state-funded priorities, like education, or by raising taxes. They may also start making decisions about what kinds of so-called “optional Medicaid services” to no longer fund, in order to cut costs. That could mean no longer covering dental care, for example, or home care.

It’s not as if it’s just Democrats in Alaska worried about the damage this bill will do to the state.

“Alaska cannot afford to lose health care funding,” Bryce Edgmon, the state’s independent House speaker, and Cathy Giessel, the state’s Republican Senate majority leader, said last week in a New York Times opinion piece titled “Alaska Cannot Survive This Bill.”

“Work requirements instituted in Medicaid are untenable for rural Alaska, with many communities facing limited broadband access and job opportunities,” they wrote. “Alaskans who lose health care coverage will be forced to delay care until it’s an emergency. In desperation, they will end up in emergency rooms, the most expensive place to receive care, resulting in higher premiums for private sector employers and unworkable finances that will most likely force rural hospitals to close.”

“The reality is that most Alaskans on Medicaid are already working,” said the Alaska legislators, “and these provisions just create more barriers and bureaucracy.”

Murkowski and fellow Alaskan Republican Sen. Dan Sullivan knew Trump’s tax bill would have this effect on their state when they voted to pass it. That’s why they tried three separate times, unsuccessfully, to insulate Alaska from the pain of the bill’s Medicaid cuts in the frantic final hours of the Senate’s debate, according to a Senate Finance Committee staffer familiar with the senators’ final efforts on the bill.

In plain view of reporters watching the Senate floor, aides to the Alaska senators haggled with the Senate parliamentarian, a.k.a. the rules referee, to try to add language to the bill at the last minute to increase the federal Medicaid match for states with the highest levels of poverty under federal guidelines. Alaska and Hawaii lead that list. But the parliamentarian said the change didn’t comply with Senate budget rules, and denied it.

So the senators tried again, this time by proposing new language to boost the federal Medicaid match for five states with the lowest population densities. Alaska tops that list, along with Wyoming, Montana, North Dakota and South Dakota. The parliamentarian said this also violated Senate budget rules and rejected it.

In a third and final effort to shield Alaska from the bill’s pain, aides to the senators tried to add more money to the bill for the state’s Community Navigator services. These programs help connect people in various communities, particularly tribal communities in Alaska, with the resources they need. The parliamentarian scratched this plan, too.

The fact that Alaska’s Republican senators were scrambling on the Senate floor at the 11th-hour to do something — anything — to protect their state from the bill’s Medicaid cuts speaks volumes about how badly they wanted to avoid the effects of the GOP bill.

A Murkowski spokesperson did not respond to a request for comment about why she voted for the bill knowing that, even with its added perks for Alaska, it would still hurt so many of her state’s most vulnerable residents, never mind millions of people outside of her state.

Who knows if Murkowski could have tanked Trump’s signature tax package for good if she’d voted against it? Sen. Rand Paul (R-Ky.), who did oppose it, said he would have supported it if GOP leaders changed a provision in it related to the government’s legal borrowing limit. In that scenario, with Murkowski and Paul swapping votes, the bill still would have passed the Senate but without Murkowski’s goodies for her state in it.

“When I saw the direction this was going, you can either say, ‘I don’t like it,’ and not try to help my state, or you can roll up your sleeves,” she told NBC’s Ryan Noble, shortly after the bill cleared the Senate.

Not that that justifies Murkowski’s vote, or anyone’s, for such a cruel bill. The reality is that virtually every Senate and House Republican voted for this legislation, and they all know that it’s going to kick down the poorest and most vulnerable people in their states or districts. What sets Murkowski apart from the rest is that it actually weighed on her.

In a Tuesday interview with Alaska reporters, not long after she’d casted her vote, she tried to talk about “good things” in the bill, citing its tax cuts, its child tax credits and its new funds for the Coast Guard. She again criticized its rushed process, and said it’s “not a perfect bill by any stretch of the imagination.”

Murkowski said nothing about being the deciding Senate vote on legislation that will kick 12 million peopleoff of their health coverage and take food aid away from millions more low-income people and families. Instead, she emphasized her commitment to sparing her constituents from some of the pain she had just voted to impose on everyone else.

“I needed to make sure that Alaska’s interests were represented,” she said. “I think I did, I think I did well by the state, in terms of trying to get these accommodations.”